Noncancer Deaths in Breast Cancer Patients
Noncancer Deaths in Breast Cancer Patients
February 14, 2008 — Oncologists should be paying attention to noncancer-related medical problems in addition to focusing on the cancer, particularly those who treat breast cancer patients. This is the message in an editorial accompanying a study showing that older breast cancer patients are more likely to die from causes other than breast cancer. Both the paper and the editorial appear in the February 20 issue of the Journal of the National Cancer Institute.
"As deaths from breast cancer fall and the population ages, breast cancer patients are increasingly likely to die of other illnesses. Thus, appropriate treatment of medical conditions other than breast cancer is critical for our patients' overall health," write editorialists Sharon H. Giordano, MD, MPH, and Gabriel N. Hortobagyi, MD, FACP, both from the department of breast medical oncology at University of Texas M.D. Anderson Cancer Center, in Houston. Although the study did not provide information on specific causes of death, it showed that cardiovascular disease at baseline significantly increased the risk for death from other causes, and that osteoporosis at baseline increased the risk for death from other malignancies.
The editorialists focus on cardiovascular disease because, as the leading cause of death in the United States, it is likely to have been a contributing factor in the deaths of many of these patients, they say. "Cardiovascular disease is of particular concern to breast cancer patients because of its prevalence and the fact that many therapies for breast cancer can cause cardiac dysfunction," they write. "Breast cancer survivors should have regular assessment of cardiovascular risk, as should all women, but the extent to which cancer survivors are receiving this care is uncertain."
The study is reported by Judith-Anne Chapman, PhD, from Queen's University, in Kingston, Ontario, and colleagues on behalf of the National Cancer Institute of Canada Clinical Trials Group. They report data from the group's MA.17 trial, which involved 5170 breast cancer patients who were disease-free after approximately 5 years of adjuvant tamoxifen therapy, and who were then randomized to receive either the aromatase inhibitor (AI) letrozole (Femara, Novartis) or placebo. During a median follow-up of 3.9 years, 256 deaths were reported — 102 from breast cancer, 50 from other malignancies, 100 from other causes, and 4 from unknown causes.
Nonbreast cancer deaths were more common than deaths from breast cancer, the researchers point out, accounting for 60% of deaths overall. This figure was even higher (72%) among women who were 70 years of age or older, but fell to 48% among women 70 years and younger.
"The results of this study point out that medical attention to the potential of death from other causes becomes increasingly important in older populations of patients with breast cancer," Dr. Chapman and colleagues conclude. "It becomes important at a general societal level to consider relative survival from breast cancer, which takes into account other risks of mortality in the population at large."
The editorialists point out that results from a similar study with the AI anastrozole (Arimidex, AstraZeneca), the Arimidex Tamoxifen Alone or in Combination (ATAC) trial, show a similar pattern, in that 60% of all the reported deaths were from causes other than breast cancer. This high risk for death from other causes might explain why it has been difficult to show overall survival benefits in the AI trials, they comment.
They also point out that the population of patients in these AI trials is not representative of all breast cancer patients. The patients in these trials had estrogen-receptor-positive or unknown tumors and were still disease-free after 5 years on tamoxifen, so they had a good prognosis. Dr. Chapman and colleagues add that younger women, who tend to have hormone-receptor-negative disease and shorter survival, were excluded from their trial.
One coauthor of the study, James N. Ingle, MD, from the department of oncology at the Mayo Clinic in Rochester Minnesota, has received honoraria from Novartis, and another coauthor, Paul E. Goss, MD, PhD, from the department of hematology and oncology at Massachusetts General Hospital Cancer Center, Harvard Medical School, in Boston, has received consulting honoraria from Novartis, AstraZeneca, and Pfizer. The editorialists have disclosed no relevant financial relationships.
J Natl Cancer Inst. 2008; 100:252-260.
February 14, 2008 — Oncologists should be paying attention to noncancer-related medical problems in addition to focusing on the cancer, particularly those who treat breast cancer patients. This is the message in an editorial accompanying a study showing that older breast cancer patients are more likely to die from causes other than breast cancer. Both the paper and the editorial appear in the February 20 issue of the Journal of the National Cancer Institute.
"As deaths from breast cancer fall and the population ages, breast cancer patients are increasingly likely to die of other illnesses. Thus, appropriate treatment of medical conditions other than breast cancer is critical for our patients' overall health," write editorialists Sharon H. Giordano, MD, MPH, and Gabriel N. Hortobagyi, MD, FACP, both from the department of breast medical oncology at University of Texas M.D. Anderson Cancer Center, in Houston. Although the study did not provide information on specific causes of death, it showed that cardiovascular disease at baseline significantly increased the risk for death from other causes, and that osteoporosis at baseline increased the risk for death from other malignancies.
The editorialists focus on cardiovascular disease because, as the leading cause of death in the United States, it is likely to have been a contributing factor in the deaths of many of these patients, they say. "Cardiovascular disease is of particular concern to breast cancer patients because of its prevalence and the fact that many therapies for breast cancer can cause cardiac dysfunction," they write. "Breast cancer survivors should have regular assessment of cardiovascular risk, as should all women, but the extent to which cancer survivors are receiving this care is uncertain."
The study is reported by Judith-Anne Chapman, PhD, from Queen's University, in Kingston, Ontario, and colleagues on behalf of the National Cancer Institute of Canada Clinical Trials Group. They report data from the group's MA.17 trial, which involved 5170 breast cancer patients who were disease-free after approximately 5 years of adjuvant tamoxifen therapy, and who were then randomized to receive either the aromatase inhibitor (AI) letrozole (Femara, Novartis) or placebo. During a median follow-up of 3.9 years, 256 deaths were reported — 102 from breast cancer, 50 from other malignancies, 100 from other causes, and 4 from unknown causes.
Nonbreast cancer deaths were more common than deaths from breast cancer, the researchers point out, accounting for 60% of deaths overall. This figure was even higher (72%) among women who were 70 years of age or older, but fell to 48% among women 70 years and younger.
"The results of this study point out that medical attention to the potential of death from other causes becomes increasingly important in older populations of patients with breast cancer," Dr. Chapman and colleagues conclude. "It becomes important at a general societal level to consider relative survival from breast cancer, which takes into account other risks of mortality in the population at large."
The editorialists point out that results from a similar study with the AI anastrozole (Arimidex, AstraZeneca), the Arimidex Tamoxifen Alone or in Combination (ATAC) trial, show a similar pattern, in that 60% of all the reported deaths were from causes other than breast cancer. This high risk for death from other causes might explain why it has been difficult to show overall survival benefits in the AI trials, they comment.
They also point out that the population of patients in these AI trials is not representative of all breast cancer patients. The patients in these trials had estrogen-receptor-positive or unknown tumors and were still disease-free after 5 years on tamoxifen, so they had a good prognosis. Dr. Chapman and colleagues add that younger women, who tend to have hormone-receptor-negative disease and shorter survival, were excluded from their trial.
One coauthor of the study, James N. Ingle, MD, from the department of oncology at the Mayo Clinic in Rochester Minnesota, has received honoraria from Novartis, and another coauthor, Paul E. Goss, MD, PhD, from the department of hematology and oncology at Massachusetts General Hospital Cancer Center, Harvard Medical School, in Boston, has received consulting honoraria from Novartis, AstraZeneca, and Pfizer. The editorialists have disclosed no relevant financial relationships.
J Natl Cancer Inst. 2008; 100:252-260.
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